'Forced' sterilisation of HIV women violates rights

Women's advocacy groups are lodging a formal complaint against the "coerced" sterilisation of HIV-infected women, saying it defies state policy.

Three women’s rights advocacy groups have lodged a formal complaint with the Commission for Gender Equality (CGE) protesting the "ongoing forced/coerced sterilisation of women living with HIV in South Africa".

Speaking at a media event on Wednesday, representatives from two of the three groups, Her Rights Initiative (HRI) and the Women’s Legal Centre (WLC), argued that forcing HIV-positive women to get sterilised defies state policy and violates their human rights.

The complaint is based on 48 documented cases where HIV-positive women were sterilised without their consent or coerced into signing consent form for sterilisation. These cases reportedly took place in Gauteng and KwaZulu-Natal between 1986 and 2014.

Zanele* is one of the women whose case was documented. She was only 19 years old when she was "coerced into undergoing sterilisation". Speaking at the event, she recalled going in for a consultation when she was 38 weeks pregnant. During the consultation her doctor asked her about getting sterilised.

"As I was thinking about it, [the doctor] turned to this lady who was with her, I think she was an intern, and said we [referring to HIV-positive women] were a problem to the hospitals, we give birth all the time … at that time I felt guilty as a patient," Zanele said. "Then [the doctor] came back and asked me if I wanted to be sterilised and I said yes."

Coerced 'while in labour'Zanele’s experience was similar to that of most women in the case studies, which HRI and the University of Kwazulu-Natal Health Economics and HIV Research Division have been documenting since 2011. Most of the women say they were coerced into signing consent papers while they were in labour. Some say doctors refused to help them deliver their babies if they didn’t sign.

According to the Sterilisation Act, healthcare providers must explain to women the process and consequences of sterilisation, and obtain their written consent only after making sure that patients understand what they are signing, said Jody-Lee Fredericks from WLC.

In most cases "we found that the healthcare workers skipped all those steps and went straight into giving the women a consent form. By the women signing, they felt that legal consent was obtained, when in actual fact it wasn’t," she said.

Demand investigationTo fix this problem, these advocacy groups demand that the CGE launch an investigation into documented cases of forced and coerced sterilisation. They further call for reforms in laws and training of healthcare workers, and redress for victims of illegal sterilisations.

Forced and coerced sterilisations are taking place despite the fact that medicine for the prevention of mother-to-child transmission of HIV (PMTCT) is available, said Ann Strode, a law lecturer at the University of KwaZulu-Natal who was involved in documenting the case studies.

In the public sector, antiretroviral (ARV) treatment is available to HIV-positive women and their babies to help prevent the transmission of HIV from mother to child during pregnancy, childbirth, and breastfeeding. In South Africa only 2.7% of HIV-positive women giving birth transmit the virus to their babies, according to government estimates.

Ongoing stigmaThe prevalence of illegal sterilisations in light of these existing treatments speaks to the ongoing stigma against women living with HIV, said Sixolile Ngcobo from Oxfam, an international non-governmental organisation which is supporting the complaint.

"There will be those who will say ‘Why do they want to have babies? Who is going to take care of those babies when they die?’ But the truth is once you are on treatment and you adhere to your treatment you can live a very long life as anyone else."

Other countries where allegations of forced or coerced sterilisation have been reported include Namibia, Swaziland and Kenya. Currently five HIV-positive women in Kenya are suing their government and two international non-governmental organisations to seek redress for illegal sterilisations performed on them. Last year the Gauteng Health Department agreed to pay a woman nearly half a million in damages for suffering she endured as a result of forced sterilisation.

*Not her real name

Joan Koka is a master’s student from the University of Missouri, Columbia. She is currently an intern with the Mail & Guardian’s health desk, Bhekisisa.